右美托咪定或芬太尼复合丙泊酚靶控输注在宫腔镜诊治中的对比观察

目的观察右美托咪定或芬太尼复合丙泊酚靶控输注用于宫腔镜手术的安全性和有效性。方法将择期行宫腔镜手术的90例患者随机分为D、F、N组，D组患者麻醉前10min内泵入右美托咪定0．5μg／kg，F组静脉注射芬太尼1阻g／kg，N组注射生理盐水10ml，注射完毕后即刻给予丙泊酚靶控输注，并根据手术刺激及患者反应调整靶浓度。观察3组患者麻醉前（T0）、丙泊酚诱导完成后5min（T1）及术毕5min（T2）的平均动脉压（MAP）、心率（HR）、呼吸频率及血氧饱和度变化；记录丙泊酚总用量、手术时间、丙泊酚停止输注至患者呼唤睁眼时间；评价麻醉效果，苏醒后5min的视觉模拟评分（VAS）。结果D、F组患者的手术时间、苏醒时间明显短于N组，丙泊酚用量明显少于N组（P〈0．05）；D、F两组间比较，差异无统计学意义（P〉0．05）。3组患者的MAP、HRT1、T2较Tn明显降低（P〈0．05），且D、F组与N组比较，差异有统计学意义（P〈0．05），D组与F组比较差异有统计学意义（P〈0．05）。D、F组血氧饱和度最低值明显高于N组（P〈0．05），D、F组间比较，差异统计学意义（P〉0．05）；D、F组的麻醉效果及苏醒后5minVAS明显优于N组（P〈0．05）。结论0．5μg/kg右美托眯定或1μg/kg芬太尼复合丙泊酚用于宫腔镜诊治手术较单纯应用丙泊酚更安全、有效。

Comparison of dexmedetomidine or fentanyl combined with propofol target controlled infusion in the diagnosis and treatment of hysteroscopy

Objective To evaluate the safety and effect of dexmedetomidine or fentanyl combined with propofol target controlled infusion in the diagnosis and treatment of hysteroscopy. Methods 90 cases of patients who were taken hysteroscopin surgery were randomly divided into group D,F and N,0.5 μg/kg dexmedetomidine was pumped into group D within 10 min before anesthesia,1 μg/kg fentanyl was injected to group F,10 ml normal saline was injected to group N, propofol target controlled infusion was instantly given to the three groups,target concentration was adjusted according to the surgical stimulation and patient response.The mean arterial pressure （MAP）,heart rate （HR）,respiratory rate and oxygen saturation was observed before anesthesia （T0）,5 min after the completion of propofol-induced （T1） and 5 min after surgery （T2）;total amount of propofol,operation time,time of propofol infusion to the patient to stop calling eye opening was recorded;the effect of anesthesia,5 min after awakening visual analog scale （VAS） was evaluated. Results The operation time,recovery time in group D and F was significantly shorter than that in group N,the amount of propofol was significantly less than that of group N （P〈0.05）;there was no significant difference between group D and F （P〉0.05）.MAP, HR of 3 groups at T1 and T2 significantly decreased compared with To （P〈0.05）,and there was significant difference between group D,F compared with group N and group D compared with group F （P〈0.05）.The minimum value of oxygen saturation in group D and F was significantly higher than that in group N （P〈0.05）,and there was no significant difference between group D and group F （P〉0.05）;the effect of anesthesia and 5 min VAS after awakening in group D,F was better than that in group N （P〈0.05）. Conclusion 0.5 μg/kg dexmedetomidine or 1 μg/kg fentanyl combined with propofol is more safely and effective for diagnosis and treatment of hysteroscopy surgery than single-applied propofol.